View
32
Download
1
Category
Preview:
DESCRIPTION
Musculoskeletal Trauma. April Morgenroth EMT, RN, BSN. Musculoskeletal System. Cartilage: softer than bone but provides structure. Bones: Provide structure and protect organs. Muscles: serve to connect musculoskeletal structures and allow movement. Tendons: connect muscles to bones. - PowerPoint PPT Presentation
Citation preview
Musculoskeletal Trauma
April Morgenroth EMT, RN, BSN
Musculoskeletal System
Bones: Provide structure and protect organs
Muscles: serve to connect musculoskeletal structures and allow movement.
Ligaments: Support joints by attaching bones to bones
Tendons: connect muscles to bones
Cartilage: softer than bone but provides structure
us.dk.com/.../humanbody/img/image_body002.jpg
Injuries to the Joint
Luxation: Total dislocation of joint.
http://commons.wikimedia.org/wiki/Image:Luxation_acromioclaviculaire.jpeg
Subluxation: Partial dislocation of a joint.
Pain
Swelling
Decreased Range of Motion
Deformity
Possible Altered Sensation
Clinical Presentation
Splint dislocations in the position found, treat pain, consider anti inflammitory
Sprains and Strains
• Sprain: Overstretching of the ligaments
12.31.13.9/.../media/medical/hw/n5551877.jpgwww.horseholistics.com/images/Img29.gif
Strain: stretching or tearing of the muscle or tendon
Pain
Swelling
Bruising
Weakness
Initial Management
Rest
Ice
Compression
Elevate
Ibuprofen or other non steroidal anti inflammatory
Fractures: Simple vs. Compound
http://www.nlm.nih.gov/medlineplus/ency/imagepages/8856.htm
Simple Fracture: The bone is fractured but the skin remains intact.
Compound Fracture: The bone is fractured and has pierced the skin. There is communication between the bone and the outside environment.
http://images.medicinenet.com/images/illustrations/typical_fractures.jpg
Fractures: Non-displaced vs. Displaced
• Non displaced fracture: fracture is present but the bone ends are still aligned
• Displaced fracture: fracture is present but the bone ends are displaced. The fracture will need to be reduced before casting in order to heal properly.
Fracture AssessmentMechanism of Injury
Pain
Swelling
Deformity (may or may not be present)
Decreased Range of Motion
Decreased function
Always circulatory, motor, and sensory distal to the injury
Crepitus
X-Ray
http://www.humanillnesses.com/original/images/hdc_0001_0001_0_img0046.jpg
Splinting• Why do it?Prevent further injury: Further movement of
bone ends may cause shearing injury to surrounding tissue.
Control bleeding: immobilizing the injury will help damaged blood vessels form clots to stop the bleeding.
Minimize pain: moving the injured part may cause more pain and further injury.
Splinting
•Remove restrictive clothing (shoes)
•Immobilize the joint above and below the injury
•Apply the splint with as little movement as possible to the injured part
•Secure the splint snugly, enough to restrict movement but not too tight.
•Always check circulatory, motor, and sensory after applying a splint. •Reassess frequently.
Compound Fractures
Never attempt to realign a compound fracture!
Gently cover the open wound with sterile dressings.
Splint in the position found.
Evaluate and treat the patient for signs and symptoms of shock.
Provide pain control as ordered.
This patient may need surgery to repair the fracture.
High risk for infection, consider antibiotics
Rib FracturesAssessment:Pain, swelling, and/or bruising over the injured area.May or may not be deformityPain will be worse when deep breathing, coughing, or palpated. Note, work of breathing, respiratory rate, oxygenation, heart rate, symmetry in chest rise.
Flail chest: Paradoxical chest wall movement during breathing. Caused by multiple rib fractures resulting in floating rib segments. This is an emergency!
www.netterimages.com/.../000/000/198-150x150.jpg
Treatment of Rib Fractures• Treating pain will help make
breathing easier for the patient.• Do not place anything completely
around the chest, this may restrict breathing. Have patient hug a pillow when coughing or deep breathing.
• You may use the patients own arm to splint a rib fracture by sling and swath method.
• Encourage coughing and deep breathing in spite of pain as this will help to prevent fluid accumulation in the lungs.
Hip Fracture
www8.georgetown.edu/dml/facs/graphics/gallery.htm
In the case of Hip fracture:
•Mechanism of injury•Pain, swelling, bruising, deformity•Lateral rotation or shortening of the injured leg•Check sensory, motor, circulation in the affected leg•Treat pain•Monitor vitals•Keep the patient in position of comfort•Pt may need surgery to repair the fracture
Fractures of the Pelvis•Can cause life threatening bleeding•May be stable or unstable•Check stability of the pelvic girdle•Evaluate and treat the patient for shock•May have bleeding into the abdomen, check for signs and symptoms.•X-ray of pelvis and chest •An unstable pelvic fracture will need splinting.•Pt will may need surgery
Picture of blanket splint
Complications
Bleeding:• Bones bleed when broken • Trauma to the surrounding area from bone ends or
fragments.• Check for bleeding and signs of circulation• Control bleeding as able• Evaluate and treat signs and symptoms of shock
Complications
Infection• Compound fractures are at high risk for
infection, treat with antibiotics prophylactically
• Pain related to rib fractures may cause a patient’s breathing to become shallow and put them at risk for pulmonary complications
Complications
Deep Vein Thrombosis• Evaluate circulation frequently • Pulses, capillary refill, skin
temperature and color• DVT signs and symptoms:
edema, redness, cyanosis, absent pulses, warm, pain
• Prevention: early ambulation, physical therapy
www.clotcare.com/clotcare/images/dvt4.jpg
ComplicationsCompartment Syndrome• Increased pressure in an enclosed
compartment restricts circulation and causes tissue damage and/or necrosis
• Pressure may be caused by swelling and inflammation, bleeding into the space
content.answers.com/.../300px-Fasciotomy_leg.jpg
•Notify MD immediately, pt may need fasciotomy, loosen splint, do not ice or elevate
•Look for: signs of decreased circulation. pain, pallor, pulselessness, paralysis, pressure, and numbness
Complications
Fat Embolism• Occurs when fatty tissues enter the blood
stream and are lodged in the narrowing blood vessels
• Signs and symptoms will be similar to DVT unless the embolus is lodged in the lung or brain
• If embolus is lodged in the brain, neurological deficits may result from hypoxic brain injury
Pulmonary Embolism• Obstruction of the pulmonary artery
or one of its branches• Clot usually forms in the veins and
then lodges in the pulmonary artery• Shortness of breath, hypoxia,
tachycardia, cyanosis, anxiety, sudden death
• Do: x-ray and EKG to rule out other causes, monitor vitals and oxygen saturation, provide supplemental oxygen, keep the patient calm and quiet
http://jaapa.com/issues/j20060701/screen/pulmonary0706art.gif
Pneumonia
• Pain related to rib fractures may cause a patient to breathe shallow and put them at risk for a atelectasis and fluid build up in the lungs which may cause pneumonia
• Prolonged immobility may also lead to build up of fluid in the lungs
• Prevention: coughing and deep breathing exercises, treat pain, early mobility
Recommended